14th May 2013 KMPDU DOCTORS Dear Colleagues, It has been a while since I updated you on issues of concern

to our Union. This however does not mean that we have not continued to work to try achieve our objectives. In the same vein, a few have interpreted our silence to mean that the Union is no more. That is not true. Indeed, we are strong and will only get stronger. OVERALL STRATEGY At the end of last year, we appreciated that the times called for a different tact in handling certain issues. Our preceding engagements had at times been abrasive, often necessarily so at the time, but this had also served to close certain doors and remove any kind of goodwill in certain areas. To move forward, we made a deliberate decision to repackage the same content in more palatable ways. Indeed these times call for such and we believe some of the progress we have made are a consequence of this. CBA We concluded our CBA negotiations earlier in the year, covering a range of issues from pay, to working hours, training, postings, recognition of those working in rural and hardship areas, disciplinary processes and also taking into account special interest groups such as registrars and interns e.t.c. This is perhaps the biggest item of this KMPDU office's term. Indeed negotiated agreementss are never perfect but as a team we find the current agreement acceptable and definately a big improvement from where we are. We do owe a big debt to the Chairman of the CBA committee, Senior Deputy Secretary Mwango, and Ministry officials with whom we worked as a team over months, Mr Njoroge, Mr Waiganjo, Mr Bolo, as well as others from within and outside Afya house, who worked on this. As you may know, all pay proposals are to be subjected to the relatively binding advice of the SRC. We have been continuiously exploring options to safeguard the work of the multipartite CBA team pending the advice of the SRC. In the last two weeks, our Secretary General has led NEC members in these efforts and our prayer, in which you should join me, is that this week will give very good results. CABINET SECRETARY The Cabinet Secretary has been nominated and the vetting process is complete. Barring any event of astronomic proportions, Mr Macharia will be our Cabinet Secretary. Irrespective of our preferences, we must now prepare to accord him due respect and our full support. Indeed we must work on appraising him of the key challenges in our sector and what would be necessary to make it better. Once appraised, there is a fair chance that he would share in our goals and bring about the changes we seek. This must also be a wake-up call to our colleagues in positions of leadership in our health institutions that they must improve governance and service delivery in a noticeable way. The period of keeping boats steady and toeing lines surely must end. If one finds themselves short of new ideas to inject and work towards, they must not hesitate to give a chance to other people with new ideas. Ladies and gentlemen, we must prove to our country that we are capable managers because we are. Even as we do this, be aware that the post of the Principal Secretary may came with similar challenges. In the process, we will have to be alive to not just practical arguments, but also the political argument as well as our persuasion in the latter. In all these, if anything objectionable

should arise, we must all remember to be respectful and impersonal going about it as the eventual outcome relies heavily on political arguments and our Principal Secretary will be our Prncipal Secretary. Overall, we did speak out because we had to, not for this season's sake but for the sake of future seasons. The message that we will not simply roll over is important. The misperceptions about doctors and management are like a hard rock that we have to chip away at, slowly. IINTERNSHIP Interns were posted, for the first time in three years, without the need for a demonstarion. As usual, no money was allocated to them in the budget, and the responsibilty for their posting was left to KMPDU. Here, we owe a huge debt of gratititude to the outgoing PS Finance, Mr Kinyua for making this happen. We recognize intern leaders Drs Njoroge, Hezron and team who helped coordinate the interns and were part of the negotiations. It was also a success for our new approach, though blemished at the end by a very small group of our young colleagues who after getting news of the satisfactory conclusion, felt that it was necessary to at least demonstrate at PS Finance office, for the satisfaction of it. KIU interns who finished in April are yet to be posted but we are working on it. We also expect KU interns to finish in August. We have satisfactorily captured this important phase in our CBA. REGISTRARS FEES The Ministry recently released the fees for our registrars especially the part ones who had not recceived a single penny. I apologize for the duration of time it has taken though I believe we did the best we could in the circumstances. It took quite a bit of work. Our position remains that 100% of fees must be paid in a timely fashion for more doctors. This matter is also captured in the CBA. The hiring of registrars was indeed approved. The issues around the budgetary allocation for this is similar to what we had for interns. It remains the stumbling block that has dragged on for months but we hope to see its end. I have deliberately avoided apportioning responsibility for the ommission. While we could have tried to follow this matter more aggressively, stepping on toes stood to bear a greater negative impact on many more doctors including the registrars, at this time. MEDICAL BOARD We empathize with the board's need for better, stronger financial position. We also seek to work in partnership with KMPDB to enhance regualtion of the sector. However, there have been a number unchallenged rises in levies, or new levies altogether, recently. The latest one is the requirement of a certificate of good conduct different from the one given by the CID, and one that has to be obtained from the board at a cost of 20,000. This is completely unacceptable and we believe illegal having been done without the magical consulations. We are asking our members, again with full sympathy to the medical baord, to not pay these fees. We will be going to court this week to challenge it. Other than that, we will be working with the board on a number of regulation issues. THE HEALTH BILL AND HSC This is being reviewed and hopefully will be enacted in a form that is favourable for the sector and the country. We have renewed lobbying for the establishment of a HSC and will be convening a meeting with sector-wide stake holders to promote buy in and to ensure we are all talking from the same script. The previous cabinet did in fact approve this but the form in which it was presented to parliament needs to be reviewed.

PATIENTS' CHARTER Working with the Medical board and other stakeholders, we concluded a patients charter. Here, there was a sinister attempt to put doctors under the authority of medicolegal lawyers through the establishment of a so called independent tribunal. This tribunal of 14, consisting of at most 1 doctor and 3 lawyers, with other members drawn from various quarters was to have the authority to review cases of negligence and suspend doctors, withdraw their licences, close down health insitutions, award financial settlements in a manner that was final and not appealable outside court. Not surprisingly, Professor Kiama Wangai was part of the team that came up with it and needless to say we shot it down. However, we need to wake up to the fact that doctors are increasingly becoming targets of ambulance chasers who have hitherto had access to easy money due to our lack of a coordinated response. MEDICOLEGAL ISSUES There is an increasing number of lawyers who have identified the medical profession as a gold mine. The number of malpractice suits are increasing. Whereas malpractice does exist and we need to work to minimize them, the cases that are pursued often lack merit and are often medicolegal lawyer induced with the hope of huge out of court settlements. These are often however prosecuted in the court of public opinion where facts don't matter much. We have seen some of this in recent newspaper articles. These ambulance chasing lawyers have actually organized themselves quite well and I am reliably informed that there is a fairly new medicolegal unit that has been set up at LSK, part of their job being to train lawyers on how to sue doctors and provide them with expert opinons. And they have done well too scoring millions of shillings in settlements from hospitals and doctors who prefer not to be dragged through bad publicity, notwithstanding the fact that they did nothing wrong. If we do not act now, this practice will become cultural. Already, we are seeing atrocious articles as we saw on a recent daily - The author of the article will be hard pressed to provide citations to the research he made reference to and we are responding in writing. The problem is that we allow individual victim doctors to take face these organized groups alone, giving little room for justice. In this regard, I am asking us all to wake up to the reality of medicolegal suits even when we do our work diligently as many of them are no more than money making schemes. I will also set in motion the creation of a specialized and dedicated team of medicolegal defence lawyers to have a central, competent and formidable team that will work to defeat ill conceived suits. We need to start counter-suits for libel and defamation against those who engage in these vices targetting our colleagues. It is overdue. This will however be a massive undertaking that will need to include all the medical bodies, consultants, insurance companies as well as our Union. Let us all please fully support this when the time comes. We all need to ensure that we are covered against legal suits that may arise out of our line of work. MOTOR VEHICLE INSURANCE FOR DOCTORS I am pleased to inform you that we have recently concluded negotiations and enterred a deal with Britam to provide enhanced comprehensive motor vehicle insurance for KMPDU members at 3.5%. This is the lowest rate allowed by the inusrance regulator, but we have also secured enhancements in addition to the higher limits of liability: personal accident cover for the driver, loss of personal effects, free coverage throughout east africa, unlimited towing and windscreen cover , optional 24hr countrywide AA rescue at a discounted annual rate of three thousand e.t.c.

This is not the only offer we looked at. We received competing offer from Phoenix and APA through a brokerage firm. We invited presentations from both parties and negotiated over a 2 week period. At the end of the day, we were obligated to direct our members to a place we had confidence that claims would be paid promptly when thay arose. Britam is one of the leading insurance companies in the region. It currently ranks second after Jubilee in claims processing and was ranked best overall company soemtime in the last few months. I was also reminded that doctoss are still regarded highly in some quarters. This deal was considered a big important one and we met three senior managers including the General Manager to help get over a sticking point. However, what we leveraged was large numbers of respectable, low risk clients. In this regard, it is our prayer that none of us will abuse this deal. Additionally, it is important that we all consider taking up insurance under this package. If uptake does not exceed 1000 doctors in the year, there is a possibilty that the offer will not be available next year. On the other hand, if successful, it opens up an opportunity to leverage our numbers in other areas including PI and low interest loans with other insitutions. The full details of the cover are on our website, www.kmpdu.org. It is open to any doctor with a DU number and one may call Mrs Hannah on 0723328150 to take it up. PURPOSE OF THE UNION As a Union, we have great members and it is priviledge to be one of the leaders of KMPDU. We must however remember that our overall role is to improve welfare of members and improve public sector healthcare delivery. We are not a business and our engagement with money is primarily to facilitate the above mentioned goals. I say this because we recently sought to employ full time Union lawyer but met opposition citing it as an extra expense. Ladies and gentlemen, we need a lawyer who does nothing but represent and advice KMPDU on legal matters. This is very important in moving us towards our key goals. For example, we need to challenge the ring-fencing ruling, and the new board rates. We did not have a lawyer during most of the CBA, there are many work condition related issues that individual members need representaion on e.t.c This is capacity we need to build. Many of the good lawyers we get also have many other cases and are therefore not usually able to give us the full attentin we need. Ladies and gentlemen, our Union is not a business. The money we collect from members is not meant for improving the face of the balance sheet but to facilitate the improvement of terms for our doctors. Unless in a case of debt or clear fiscal impropriety, the balance sheet is not the primary determinant of performance in our union, rather it is improvements at the workplace and the payslip. KEMRI doctors who have been without call allowance for the last two years, please know that we have not forgotten you. It is not always possible to achieve all the desirable things at when needed but they will be achieved. OMNIPOTENCE Sadly, we have appreciated that we are not always able to make all things happen the way we want them to at the times we find most convenient. But such is life. We will however continue to take small strides forward and each month should leave us in a better position as a community than we were before. Indeed KMPDU remains one of the most successful unions in Kenya month on month. Fortunately, we are able to seek the favour and intervention of our omnipotent God. Let us therefore always remember to pray for our Union. Thank you. Dr Victor Ng'ani, Chairman.